South African Medical Journal - January 2023 Vol 113 No 1

Introduction

Practising in a post-truth world: Pandemic ethics can inform patient autonomy and clinical communication

An elderly man with COVID-19 pneumonia, from a geriatric frail-care facility, is admitted for supplemental oxygen.  His family are extremely anxious, as they have not been allowed to visit him and are having difficulty accessing the attending clinician.  The attending clinician has been on call for 36 hours with very few staff, as colleagues have either contracted COVID-19 or are isolating after being exposed. When the clinician calls, a family member mentions that they spoke to a nurse about their father’s treatment and would like to know why he is not receiving ivermectin. They saw Facebook posts saying that it works, adding that their general practitioner was able to source ivermectin from a veterinary supplier.  The clinician explains that until there is better evidence to support its use, hospital policy is to not use ivermectin.  The family are displeased, to put it mildly.

Acute obstructive hydrocephalus in posterior reversible encephalopathy syndrome

In 1996, Hinchey et al. described the first 15 patients with posterior reversible leukoencephalopathy syndrome (PRES).  The authors identified an abrupt increase in blood pressure, with or without renal impairment, as well as immunosuppressive therapy as risk factors. PRES affecting predominantly the posterior fossa and leading to acute hydrocephalus is extremely uncommon.  The earliest cases in the literature, reported by Verrees et al. and Adamson et al.in 2003 and 2005, respectively, illustrated the unique presentation of three patients with altered mental status, hypertensive crisis and cerebellar oedema with obstructive hydrocephalus.  These patients underwent emergency ventriculostomy and had full resolution of their neurological deficits.

A critical analysis of Discovery Health’s claims-based risk adjustment of mortality rates in South African private sector hospitals

In 2019, Discovery Health published an article in the South African Medical Journal describing its use of service claims data to determine standardised mortality rates, across hospital systems, for specific clinical conditions (i.e., acute myocardial infarction, coronary artery bypass graft (CABG) surgery, pneumonia and acute stroke).  The publication sought to transparently examine variations in care across hospitals in order to ‘support improvement efforts in the reduction of preventable deaths associated with acute inpatient care’. This publication was the first of its kind in South Africa (SA) and represents an important step towards driving quality improvement in SA’s private healthcare sector.

Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021

A 2021 publication reflected the extent to which the COVID-19 pandemic affected routine primary healthcare services (PHC) in South Africa (SA) between 2019 and 2020.  These routine services include healthcare for maternal and child health, women’s health, including contraceptive care, management of common communicable diseases such as HIV and tuberculosis (TB) and management of chronic conditions such as hypertension, diabetes, and mental health.

A doctor at a PHC clinic: A ‘must-have’ or ‘nice-to-have’?

Many patients have their healthcare needs met at primary healthcare (PHC) clinics in KwaZulu-Natal (KZN), without having to travel to a hospital. This is the situation in uMgungundlovu District, which is situated around the city of Pietermaritzburg, and has clinics in urban as well as rural areas.  There are many more clinics than hospitals, with clinics located throughout the geographic area, providing healthcare nearer to communities.  The main pillars of strength of the PHC clinics are the teams of full-time, dedicated, well-trained and hard-working operational managers and PHC professional nurse clinicians (PNs).  Medical doctors form only a part of these PHC clinic teams but offer a decentralised medical service for patients with more complex clinical conditions.

Access to postpartum tubal ligation services in Cape Town, South Africa – an observational study

Women’s health is a topic that is receiving much interest worldwide.  Reproductive health and contraception make up part of women’s health. Availability of and access to contraception is a global matter of importance.

Exploring a community’s understanding of HIV vaccine-induced seropositivity in a South African research setting

Currently, no preventive HIV vaccines have been approved by the US Food and Drug Administration.  A preventive HIV vaccine is given to people who do not have HIV, with the goal of preventing HIV infection by inducing protective anti-HIV immune responses.  However, this may cause a reactive result in routine HIV testing in the absence of HIV infection.  The detection of HIV vaccine-induced antibodies by serological tests is commonly referred to as vaccine-induced sero-reactivity or vaccine-induced seropositivity (VISP).

The utility of mobile telephone-recorded videos as adjuncts to the diagnosis of seizures and paroxysmal events in children with suspected epileptic seizures

Epilepsy is largely a clinical diagnosis based on the semiology of the seizures.  The motor, sensory and behavioural signs are key in describing seizure semiology and subsequently, seizure type.  However, healthcare workers rarely witness seizures, so the events are often relayed by verbal accounts to physicians during subsequent consultations.  The physician makes deductions from caregiver descriptions.  The perceived anxiety and potential risks of not treating an affected child with possible epilepsy may result in misdiagnosis and mismanagement.  Some 20 - 30% of those referred to tertiary centres with refractory epilepsy do not in fact have epilepsy, hence the need for accurate descriptions of seizure events.